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"The essence of midwifery is staying in the moment, being humble, and paying attention... it is the antithesis of control."

- Elizabeth Davis, midwife, educator, author

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2) The Art of Midwifery

For postpartum baby blues, have the mother lie in a bath to which a few drops of jasmine oil have been added. Jasmine oil dropped on her pillowcase before she goes to sleep
at night is also helpful. If jasmine oil is not at hand, ylang ylang or clary sage oil is nearly as effective.

Few families readily perceive the full extent of the woman's vulnerability once labor has ceased. Many times, the intense focus and concentration that friends and family members direct toward the mother are abruptly withdrawn and transferred to the infant or elsewhere. Some women who are strongly dependent on this psychological/emotional
support sense the loss acutely. This may contribute to postpartum depression.

Some ways to monitor for a potential depression, allowing a timely and critical intervention, include: suggesting the mother join a support group; hiring a doula to assist in the home; enlisting friends to call every day to chat and see how the mother is doing.

- Midwifery Today Issue No. 34

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Recent studies show that breastfeeding mothers with normal hormone levels
and good social support have better adjustment to a maternal role, greater
confidence as parents, and less anxiety than bottle feeding mothers, leading
to an apparently reduced risk of postnatal depression (PND). Authors of
one of the studies point out that those women at risk of PND should be
encouraged to breastfeed and should be given the social support needed
to initiate and maintain the breastfeeding relationship. Those women with
PND need to be encouraged and supported to continue breastfeeding because
it helps increase maternal confidence.

- Nursing Mothers' Newsletter, Jan/Feb 1997

Window of Fertility

Researchers at the National Institute of Environmental Health Sciences
report that the highest probability of pregnancy each month occurs during
a six-day period ending on the day of ovulation, a time frame several
days earlier and considerably shorter than has been traditionally thought.
The Institute's researchers found that all 192 pregnancies in the study
group of 221 healthy women aged 26 to 35 were initiated on the day of
ovulation or during the five previous days; none was produced by intercourse
after this interval. The probability of conception ranged from one in
ten on the fifth day prior to ovulation to one in three on the day of
ovulation.

- New England Journal of Medicine, Dec. 7, 1995

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4) Homebirth Offsets Depression

Women who give birth in a hospital are much more likely to experience postpartum depression or even post
traumatic stress disorder. British childbirth expert Sheila Kitzinger
states that the more interventions a woman experiences, the more likely
she is to be depressed, with cesarean sections obviously carrying the
greatest risk of depression.

Aidan McFarlane, a British physician, notes that while 68 percent of hospital mothers experience
postpartum depression, only 16 percent of homebirth mothers do. On The
Farm, a self contained, alternative lifestyle community in Tennessee,
the rate of postpartum depression was 0.03 percent. Almost all mothers
on The Farm had both a homebirth and a supportive, loving community of
women to assist them postpartum. Avoiding depression, in itself, would
be a major reason for mothers to consider giving birth in their own homes,
if that is where they are most comfortable, especially if they had previously
experienced postpartum depression and thus were at high risk for a repeat
episode.

Aspects of hospital birth that may strongly contribute to the incidence of postpartum depression in our
country are the way the moment of birth is handled and routine separation
of baby and mother. In a study published in the New England Journal of
Medicine in 1972, Marshall Klaus found that holding the baby close released
"dormant intelligences" in the mother and caused "precise
shifts of brain functioning and permanent behavior changes." Bonding
therefore is not just an emotional thing that only mothers think happens;
it is a biochemical process that forever changes the mother so that she
knows more instinctively how to relate to her baby. Routine separation
of mom and infant makes baby frightened and mom depressed. This may be
why postpartum depression and difficult adjustments are so common in the
United States and rare elsewhere.

Female reproductive hormones have many significant effects on the brain chemicals (neurotransmitters)
responsible for communication between brain cells, including how much
of the neurotransmitter is present, the length of time it is present between
cells, and how the receiving cell is affected by the incoming neurotransmitter.
The neurotransmitters serotonin, norepinephrine, dopamine, and acetylcholine
are known to be out of balance in serious emotional or psychiatric illnesses.
In fact, many studies have documented low levels of the metabolites (the
breakdown by-products) of these neurotransmitters in the blood, urine
and cerebrospinal fluid in clinically depressed people. Most mental health
researchers agree that dysregulation of these neurotransmitters is a causative
factor in clinical depression. Each of these neurotransmitters is modulated
by female reproductive hormones.

At least half of clinically
depressed people have a detectable abnormality in the neuroendocrine system,
called the hypothalamic-pituitary-adrenal axis, that shows up as an abnormality
of cortisol regulation. Many show another sign of hormonal dysregulation
in which their pituitary fails to react to the chemical signal to release
a hormone to stimulate the thyroid. The hypothalamic-pituitary-adrenal
axis is dramatically affected by childbearing, and it may be that although
all women experience these hormonal changes, some are vulnerable to experiencing
depression and anxiety as a result. The thyroid gland is very significantly
affected by childbearing, and we know that even subclinical cases of low
thyroid can cause depression.

It is not yet known which one
or what combination of these neurochemical agents initiates postpartum
depression (PPD). It is unlikely that there is a single cause for all
sufferers. On one end of the spectrum are women who have what seems to
be a "pure" biologic disease. They have very strong biologic
symptoms such as insomnia, weight loss, extreme fatigue, profound difficulty
getting out of bed in the morning, inability to function even minimally,
and/or hallucinations. For other women, massive stress seems to be the
major cause. Still others will feel that events in their past, such as
being abused or neglected, have left them vulnerable to depression during
any major life crisis. Some have elements of each.

Postpartum depression refers to a group of poorly defined, severe, depressive-type symptoms which usually
begin at four to eight weeks postpartum but can occur later in the first
year, and can sometimes persist for more than a year. The incidence ranges
from 10 to 16 percent of new mothers.

Symptoms are prolonged and include exhaustion, irritability, frequent crying, feelings of helplessness
and hopelessness, lack of energy and motivation so that the woman's ability
to function is disturbed, there is a lack of interest in sex, she experiences
disturbances of appetite and sleep and feelings of being unable to cope
with the new demands placed on her. Anxiety is often related to the infant's
welfare and may persist in spite of doctors' reassurances. Some mothers
with postpartum depression may lack affection for the baby, and in turn,
experience self-blame and guilt. It is not uncommon for a woman with postpartum
depression to have psychosomatic symptoms such as headache, backache,
vaginal discharge and abdominal pain for which no organic cause can be
found.

Most studies show that a person's previous history or a family history of psychiatric problems increases
the chances of postpartum depression. In most cases, however, psychosocial
factors are important. The woman may be experiencing bereavement, the
effects of unemployment or inadequate income, unsatisfactory housing,
or unsupportive relationships. The experience of childbirth may have aroused
memories of a past stillbirth or miscarriage, abortion or death of her
mother. When a woman has had a poor relationship to her own mother or
was separated from one or both parents before the age of eleven, she is
more likely to be depressed and anxious. Another factor may be the woman's
inability to confide in her partner or a friend. Women are often embarrassed
to tell another how badly she feels. Loneliness, isolation and lack of
support are serious contributors to postpartum depression. Some mothers
may find it difficult to reconcile the realities of mothering with their
prenatal fantasies.

Learn more about the postpartum period from Midwifery Today Issue No.22, on Postpartum. Get this back issue for only $6.00 plus shipping.
(Regular price: $7.00) Call 800-743-0974 to order today! Mention code
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7) From the Garden

Postpartum Herbal Bath

Start up a big pot of hot water for steeping herbs for a postpartum bath
soon after birth. Strain the tea before adding to bath water. Steeping
in glass gallon jars is very effective, then strain directly into bath
through cheesecloth placed in a plastic colander.

For the bath I combine: one quarter cup sea salt, one ounce uva ursi (bearberry),
one to two ounces comfrey, two ounces shepherd's purse, and one crushed
fresh garlic bulb.

Place a bath towel in the bottom of the tub for comfort and to prevent
slipping. Let mom enjoy the bath until she asks for baby, at which time
the baby can be introduced to the bath slowly, feet and legs first, then
bottom. The salty garlic is astringent and mildly antiseptic so immersing
the baby's cord is OK.

Since the bath is quite warm (102 to 104 degrees F), I have mom drink
three cups of a strong infusion of shepherd's purse at room temperature
soon after birth and before entering the bath.

The following are my criteria for using the herbal bath soon after birth:

- mom's uterus has good tone
- any source of significant bleeding has been identified and repaired
- the baby has been assessed and is fine
- mom is able to walk to the tub with minimal assistance
- mom and babe are not left alone in the bath

Readers, at what rate do you see postpartum blues or postpartum depression in homebirth or birth center situations? Do you think it differs from the rate it is seen following hospital births? Why or why not?

My midwives were herbalists with lots of experience under their belts. One of them made me a wonderful herbal cocktail that is delicious and effective for not only postpartum blues but for fortifying breastmilk. I make a tea from red clover, great
for purifying the blood and helping improve breastmilk; lemon balm, which
works wonderfully for lifting the spirits; red raspberry leaf, which helps
the uterine walls contract so the uterus can shrink back down to size;
and nettles, which contains vitamin K, important for clotting. Nettles
also is a good source of iron which is important for breastfeeding babies.
I steep a teaspoon of each per cup of tea for about five minutes. It is
best fresh!
It is hard being a new parent, especially if you have never done it before.
Be patient and make sure to get as much fresh air as you can.
Grace

Postpartum depression is a
serious thing. I have had it following both my pregnancies. The first
time it lasted from a couple days after my daughter's birth until about
a year later. It got a little better as time went on, but it was still
hard. My second daughter has had different effects on me. I have my good
days and my bad days. On good days, I just don't want to do anything.
On bad days, I just sit and hold my seven month old daughter. I can't
do anything. I cry and I sit. The only time I don't cry is when I'm breastfeeding
my daughter. I thought this time I was not going to get postpartum depression
because I didn't get it until four months postpartum. My husband thinks
I use PPD as an excuse not to do housework. He doesn't understand that
it is serious, and can hurt my family in a severe way. I am glad I have
my mother on line to talk to. Family can be a great help. If you think
you have PPD talk to your healthcare provider. It is a very serious thing;
I know first hand.
Amber W.

I am doing a research project
for school and am looking for information on mortality rates for newborns
and for labouring women when using a midwife and using an obstetric MD.
Any help would be appreciated. Email me at tonyandsharon@msinets.com
or write to my home address at 3917 Brickland Road South Hill, VA 23970.
Thank you.
Sharon K Varner

I am a childbirth educator
in England and will be moving to Japan for two years where I hope to have
my fourth baby. My other three were born at home using water with the
best independent, radical midwife ever! I wonder if anyone knows anything
about the system in Japan. Any information or contacts would be greatly
appreciated. Mail to claygrubb@clayncc.demon.co.uk.
Thank you!

I am an aspiring midwife finishing
my last year of an undergraduate degree in English. I have been researching
the various paths to becoming a midwife and have applied to a BSN-MSN
program in nurse-midwifery, but am not sure that it is the best route
for me to take. I am trying to understand the pros and cons of a nurse-midwifery
program versus a good direct-entry program and am curious to hear the opinions of experienced midwives on the subject. You can email me at jessial@earthlink.net.

Thanks for the great newsletter; I find it really inspirational and exciting, and thanks for any of your thoughts on my dilemma.

We look forward to hearing from you very soon! Send your submissions to mtensubmit@midwiferytoday.com. Some themes will be duplicated over time, so your submission may be filed for later use.

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